Isolation of pulmonary veins with the highest dominant frequency terminated paroxysmal atrial fibrillation more frequently than isolation of other pulmonary veins (33.3% vs 4.8%, P=0.0004).
Observational (n=31)
Does ablation of pulmonary veins with the highest dominant frequency improve the rate of acute atrial fibrillation termination in patients with paroxysmal atrial fibrillation?
Targeting pulmonary veins with the highest dominant frequency during ablation for paroxysmal atrial fibrillation is associated with a significantly higher rate of acute procedural AF termination.
Absolute Event Rate: 33.3% vs 4.8%
p-value: p=0.0004
BACKGROUND: Paroxysmal atrial fibrillation (PAF) can be treated with pulmonary vein isolation (PVI). A spectral analysis can identify sites of high-frequency activity during atrial fibrillation (AF). We investigated the role of the PVs on AF perpetuation by dominant frequency (DF) analysis. METHODS: Thirty-one consecutive patients with PAF who underwent PVI were included in the prospective study. DF was calculated in each of the PVs, 16, five, and five sites in the left atrium, the coronary sinus, and the right atrium, respectively. In patients presenting sinus rhythm at the baseline, AF was induced by pacing. The PVs were then divided into two groups; PVs demonstrated the highest DF (HDF-PV) and others. RESULTS: One patient was excluded from the analysis because sustained AF could not be induced. AF was terminated in 43.3% (13/30) of patients during ablation. Of 92 PVs isolated during AF, 30 and 62 PVs were classified into the HDF-PV and others, respectively. PAF was more frequently terminated by the HDF-PV isolation compared to the others (33.3% 10/30 vs 4.8% 3/62, P = 0.0004). Interestingly, nine of the 30 HDF-PVs showing the highest DF among all 30 regions, including extra PVs, led to AF termination in 88.9% (eight out of nine) of cases. Moreover, the HDF-PVs isolation resulted in a greater AF cycle length prolongation than the other PVs isolation (12.1±5.0 vs 2.7±7.6 ms, P = 0.007). CONCLUSION: Termination of PAF was more frequently observed during ablation of the PVs with the highest DF. The PV showing high DF played an important role in the maintenance of PAF.
Matsuo et al. (Sun,) conducted a observational in Paroxysmal atrial fibrillation (PAF) (n=31). Isolation of pulmonary veins with the highest dominant frequency (HDF-PV) vs. Isolation of other pulmonary veins was evaluated on Termination of paroxysmal atrial fibrillation during ablation (p=0.0004). Isolation of pulmonary veins with the highest dominant frequency terminated paroxysmal atrial fibrillation more frequently than isolation of other pulmonary veins (33.3% vs 4.8%, P=0.0004).
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